A systematic review of the effects of residency training on patient outcomes

<p>Abstract</p> <p>Background</p> <p>Residents are vital to the clinical workforce of today and tomorrow. Although in training to become specialists, they also provide much of the daily patient care. Residency training aims to prepare residents to provide a high quality of care. It is essential to assess the patient outcome aspects of residency training, to evaluate the effect or impact of global investments made in training programs. Therefore, we conducted a systematic review to evaluate the effects of relevant aspects of residency training on patient outcomes.</p> <p>Methods</p> <p>The literature was searched from December 2004 to February 2011 using MEDLINE, Cochrane, Embase and the Education Resources Information Center databases with terms related to residency training and (post) graduate medical education and patient outcomes, including mortality, morbidity, complications, length of stay and patient satisfaction. Included studies evaluated the impact of residency training on patient outcomes.</p> <p>Results</p> <p>Ninety-seven articles were included from 182 full-text articles of the initial 2,001 hits. All studies were of average or good quality and the majority had an observational study design.Ninety-six studies provided insight into the effect of 'the level of experience of residents' on patient outcomes during residency training. Within these studies, the start of the academic year was not without risk (five out of 19 studies), but individual progression of residents (seven studies) as well as progression through residency training (nine out of 10 studies) had a positive effect on patient outcomes. Compared with faculty, residents' care resulted mostly in similar patient outcomes when dedicated supervision and additional operation time were arranged for (34 out of 43 studies). After new, modified or improved training programs, patient outcomes remained unchanged or improved (16 out of 17 studies). Only one study focused on physicians' prior training site when assessing the quality of patient care. In this study, training programs were ranked by complication rates of their graduates, thus linking patient outcomes back to where physicians were trained.</p> <p>Conclusions</p> <p>The majority of studies included in this systematic review drew attention to the fact that patient care appears safe and of equal quality when delivered by residents. A minority of results pointed to some negative patient outcomes from the involvement of residents. Adequate supervision, room for extra operation time, and evaluation of and attention to the individual competence of residents throughout residency training could positively serve patient outcomes. Limited evidence is available on the effect of residency training on later practice. Both qualitative and quantitative research designs are needed to clarify which aspects of residency training best prepare doctors to deliver high quality care.</p

Understanding credit card payment behavior among college students

College students remain a lucrative target market for credit card companies even after the advent of the Credit Card Act of 2009. Unfortunately, many students are not prepared to use credit responsibly or make payments in a timely manner. Numerous studies reveal risky student credit behaviors, lack of credit knowledge or irresponsible management of credit. However, there remains a need for more information on college students\u27 payment behaviors. This paper aims to explain credit card payment behavior among college students by segmenting college students into payment behavior groupings. Using an online survey, students provided their credit card payment activity and demographic characteristics. The results of this study shed light on different credit card payment behaviors by segmenting college students into four behavioral segments based on useful characteristics. Clear distinctions exist between segments who behave in responsible ways versus those who do not practice responsible behaviors. These segmentation results add to the understanding of Lyons (2004; Journal of Consumer Affairs 38 (1): 56-80) who determined a means of identifying Financially at Risk students (FAR) with payment behavior. Given potentially dangerous effects of targeted credit card marketing to college students, findings about payment behavior of college students will help policymakers, credit card companies and college administrators